Agenda item

The Chairman welcomed Cathy-Anne Burchett, Associate Director of Ambulance Operations – London Ambulance Service, Graeme Marsh, System Partnership Transformation Manager – London Ambulance Service and Christine White, Bromley Group Manager – London Ambulance Service to the meeting to provide an update on the London Ambulance Service (LAS).

The Associate Director of Ambulance Operations informed Members that the new LAS Strategy 2023-28 had been launched in the autumn and some of the great work undertaken across the borough was highlighted within the slide pack.

The Chairman noted the introduction of the 45-minute handover process, which had reduced the number of ambulance hours lost at the Princess Royal University Hospital (PRUH) from 276.3 in February 2023 to 26.1 in November 2023. The System Partnership Transformation Manager said that significant challenges had been recognised in terms of handover delays, and one of the measures was to look to minimise this by introducing a timeframe. There had been challenges in terms of implementation as there was a culture of LAS crews sitting with patients for long periods of time to provide supervision and support. However, the changes to the process had now bedded in and the hospital had adjusted to how the LAS operated, ensuring that the safety of the patient was maintained. The hours saved as a result of the introduction of the 45-minute handover process were being put back into getting ambulance teams out on the road, responding to other patients that were waiting. In response to a further question, the System Partnership Transformation Manager confirmed that all patients had a clinical handover – LAS crews spoke with hospital staff and advised them of the patient’s presentation. These were generally lower acuity patients, but if they were no specific spaces available for them in the A&E the Trusts had implemented processes to oversee them safely. It was noted that escalation measures were in place to allow the LAS to support Trusts if this type of pressure was being experienced.

A Member enquired if the reasons for the December performance for Category 2 callouts appearing to be an outlier, compared to the national target, were known. The Associate Director of Ambulance Operations advised that the national target for Category 2 callouts was 18 minutes, however it had been agreed with NHS England that across the London region the LAS would work towards a target of 30 minutes, as this was more realistic. During December 2023 there had been very high acuity patients and a cold weather snap which had caused callout times to escalate up to 52 minutes. The current Category 2 callout times stood at 31 minutes for South East London and the demand was more manageable. In response to a further question the Associate Director of Ambulance Operations said that ambulance offloads varied across South East London – there were some trends in terms of  increased handover delays being seen on Mondays/Tuesdays. This was usually related to flow through the hospitals, and once this settled the delays decreased.

In response to questions, the System Partnership Transformation Manager advised that Category 1 callouts related to an immediate threat to life. Category 4 callouts were often healthcare professional admissions that were not urgent, for example a leg injury that required transportation or an abnormal blood test that required further investigation. Category 5 was a non-dispatch position – resources were not sent immediately, but the call could be kept within the service for a clinician to make contact to gather further information. These calls could also be referred into the 111 service for review.

The Portfolio Holder for Adult Care and Health noted that towards the end of the previous year the Metropolitan Police had introduced the Right Care, Right Person model, and enquired if the LAS had been impacted by these changes. The Associate Director of Ambulance Operations said this had had an impact on the LAS – there was a transition to the new process, and this was still a “work in progress”. There was a clearer, dynamic risk assessment that LAS crews had to complete in relation to mental health patients. The LAS were looking at some of the calls received and they were feeding back to emergency and external partners to identify areas of further learning.

In response to a question regarding the work with King’s College Hospital NHS Foundation Trust to champion the use of alternative care pathways, the System Partnership Transformation Manager said that this was a response to generic pressures. The LAS was working with a number of external partners to reduce unnecessary conveyances of patients to emergency departments and ensure patients were getting the most appropriate care for their needs. This included LAS crews referring patients back into primary care services or community services, and they were currently developing the urgent community response.

In response to a question regarding staff retention, the Associate Director of Ambulance Operations advised that staff were often retained with promotion into other areas of the LAS. Retention of staff was strong across South East London and there were lots of opportunities for paramedics to move to different section of the LAS.

On behalf of Members, the Chairman extended his thanks for the work being undertaken with the Council’s Youth Offending Team – as part of a rehabilitation programme, the LAS team were educating young people on the impact of knife injuries with an aim to prevent future injuries and incidents. The Bromley Group Manager advised that she could ask her team members to provide any specific feedback following the meeting.

The Chairman thanked the Associate Director of Ambulance Operations, System Partnership Transformation Manager and Bromley Group Manager for their presentation to the Sub-Committee.

RESOLVED that the update be noted.